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Articles by Kathleen Rice Simpson, PhD, RNC, CNS-BC, FAAN

Implications of Missed Care, Nurse Staffing, and the Nursing Work Environment on Patient Outcomes in Maternity, Neonatal, and Pediatric Inpatient Settings

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(5):253, September/October 2020.

In this special topics series on maternity, neonatal, and pediatric nurse staffing and the nursing work environment, we present four studies that cover challenges of practicing in stressful clinical settings including inadequate nurse staffing and unsafe environments, relative to potential implications for patients and nurses. Missed, delayed, and incomplete nursing care is now being studied in these specialty settings with a focus on links to patient outcomes. Two of the studies specifically included hospitals' adherence to the Association of Women's Health, Obstetric, and Neonatal Nurses nurse staffing guidelines as a factor in their findings and clinical implications.

Missed Nursing Care During Labor and Birth and Exclusive Breast Milk Feeding During Hospitalization for Childbirth

Simpson, Kathleen Rice; Lyndon, Audrey; Spetz, Joanne; More

MCN, The American Journal of Maternal/Child Nursing. 45(5):280-288, September/October 2020.

When maternity nurses are caring for women in the context of inadequate nurse staffing, important aspects of nursing care may be missed, delayed, or incomplete. The concept of missed nursing care is increasingly being applied to maternity, neonatal and pediatric nursing settings after many years of focus on medical-surgical units in acute care hospitals. In this study missed nursing care and inadequate nurse staffing were found to be associated with exclusive breast milk feeding during the childbirth hospitalization.

Measuring Nurses' Contribution to Care and Outcomes is a Patient Safety Issue

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(5):316, September/October 2020.

Ability to accurately and reliably measure nursing care and link with patient outcomes is a safety issue. The type and dose of nursing care that is required for optimal outcomes must be established as part of the body of evidence to support safe nurse staffing. More work is needed to identify nurse-sensitive measures in maternity, neonatal, and pediatric nursing settings.

Inclusive and Respectful Language in Scholarly Writing and Speaking

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(4):196, July/August 2020.

Inclusive and respectful language in manuscripts published in MCN is an important consideration in writing for the journal and editing accepted articles. As use of gender-neutral language and descriptions of race and ethnicity evolve and value-laden words are scrutinized, we will be helping authors make sure their scholarly work is appropriately presented in MCN.

Considerations for Active Labor Management with Oxytocin: More May Not be Better

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(4):248, July/August 2020.

Recent evidence suggests an oxytocin “rest” or discontinuing oxytocin once active labor has been established may be one way to minimize labor complications and decrease risk of cesarean birth for some women.

Birth Settings in America: Outcomes, Quality, Access, and Choice: New Report from the National Academies of Sciences, Engineering, and Medicine

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(3):137, May/June 2020.

A comprehensive report on birthing in the United States offers a detailed analysis of available choices, access to various choices, and associated risks for mother and baby. Consensus is lacking among researchers and clinicians on absolute and relative risks of adverse outcomes when comparing hospital, birth center, and home as a setting for birth. The National Academies of Science, Engineering and Medicine convened a committee of experts to examine these issues and prepare a summary of the evidence. The work of the committee was funded by the National Institute of Child Health and Human Development in response to congressional legislation sponsored by the Maternity Care Caucus including Congresswoman Lucille Roybal-Allard and Congresswoman Jaime Herrera Beutler.

Trends in Natality Data in the United States

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(3):192, May/June 2020.

There are a number of important resources to help nurses stay up-to-date on natality trends in the United States. Key data are presented with highlights on changes in the data from 2017 to 2018 collected from birth certificates. In 2018, compared to 2017, there were fewer births, teen births, cesareans, births of multiples, and more preterm births, labor inductions, and births attended by certified nurse midwives. The day and month with highest number of births remain Thursday and August, while Sunday and February are still the day and month with the lowest number of births.

Promoting Excellence in Inpatient Maternity Nursing

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(2):73, March/April 2020.

We are very pleased to offer these six articles on key aspects of inpatient maternity nursing care and hope you enjoy reading them.

Ongoing Crisis in Lack of Maternity Services in Rural America

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(2):132, March/April 2020.

Many women have limited access to basic maternity services in areas of the United States where there are no nurse midwives, nurse practitioners, family medicine physicians, or obstetricians, and no hospital with a maternity unit. Recommendations from the March of Dimes and Centers for Medicare and Medicaid Services for solving the crisis of maternity care deserts are reviewed.

New Standards for Maternal Safety in Birthing Hospitals

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(1):68, January/February 2020.

The Joint Commission has published new standards for maternal safety that will be effective this year for all their accredited hospitals. They include details of care recommended for women with obstetric hemorrhage and severe hypertension or preeclampsia. A review of the new standards and implications for practice are presented.

Listening to Women, Treating Them with Respect, and Honoring their Wishes during Childbirth are Critical Aspects of Safe, High-Quality Maternity Care

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 44(6):368, November/December 2019.

Recent surveys of new mothers suggest that we can do better in treating women with respect, listening to their concerns, and honoring their wishes during the childbirth process. The findings apply to all care providers and all birth settings, thus opportunities for improvement exist widely. Nurses are in an ideal position to lead the types of changes that are needed in maternity care.

Maternal Mortality in the United States

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 44(5):249, September/October 2019.

Maternal mortality rates in the United States compare very unfavorably with other high-income countries. The Centers for Disease Control and Prevention estimate that about 700 women die of pregnancy-related causes in the United States each year. A summary of their May 2019 report is presented. Nurses must continue to take a leadership role in efforts to reduce the unacceptably high maternal mortality in the United States.

Sepsis in Pregnancy and Postpartum

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 44(5):304, September/October 2019.

Sepsis in pregnancy and postpartum is a major cause of maternal death in the United States. As part of the continuing focus on preventing maternal mortality, new resources are reviewed, including the Society for Maternal-Fetal Medicine Consult Series on sepsis during pregnancy and the puerperium. Working together as part of an interdisciplinary team requires that all members of the team have knowledge of the most recent clinical guidelines and the ability to apply them to clinical practice.

Partnering with Patients and Families during Childbirth: Confirming Knowledge for Informed Consent

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 44(3):180, May/June 2019.

There are many opportunities during hospitalization for childbirth to offer information to the woman and her family about various options and choices for clinical care and treatment. Women should be provided information at their appropriate literacy level and language to make decisions about their care in partnership with the health care team. While events of labor and births may seem routine to clinicians, they are usually not for patients. Therefore, shared decision-making approaches and patient consent are essential throughout the childbirth hospitalization.

Immediate vs. Delayed Pushing

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 44(2):124, March/April 2019.

When a woman in labor reaches 10 cm cervical dilation, she can either begin pushing immediately or wait until she feels the urge to push. As evidence continues to evolve about advantages and disadvantages of each option, nurses must keep up-to-date and be ready to have a discussion as part of the clinical team that includes the woman as a full partner and covers the important considerations. A recent study about immediate or delayed pushing for nulliparous women with epidural analgesia is reviewed.

Predictors of Future Risks of Cardiovascular Disease Based on Pregnancy and Birth Outcomes

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 43(6):356, November/December 2018.

Cardiovascular disease is the number one cause of death of women in the United States. Emerging evidence suggests several complications of pregnancy such as hypertensive disorders, preeclampsia, eclampsia, diabetes, and preterm birth are predictive of future cardiovascular health. All women, especially those who have experienced one of these complications during pregnancy, should be screened for risk factors during their postpartum visit and subsequent well women visits so they can be aware and take steps to modify their diet and lifestyle to decrease risk of cardiovascular disease. Screening may enhance early identification so appropriate treatment can be initiated.

Racial and Ethnic Disparities in Maternity Care in the United States Put Mothers and Babies at Risk

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 43(5):300, September/October 2018.

There are dramatic differences in maternal and infant outcomes among racial and ethnic groups in the United States. Some of these disparities are due to inequitable maternity care. Potential underlying causes and solutions are discussed.

Severe Maternal Morbidity and Maternal Mortality: What Can be Learned From Reviewing Near Miss and Adverse Events?

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 43(4):240, July/August 2018.

Severe maternal morbidity and maternal mortality cases require thorough review by an interdisciplinary quality committee. Lessons learned can be used to enhance care and develop strategies for prevention of these types of adverse events.

The National Network of Perinatal Quality Collaboratives: Opportunity to Enhance the Care and Outcomes for Mothers and Babies

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 43(3):125, May/June 2018.

Clinicians, scientists, public health experts, and patients working together in state-wide perinatal quality collaboratives can significantly improve care and outcomes for mothers and babies. Supporters of these efforts include the Centers for Disease Control and Prevention, the March of Dimes Foundation, and the National Institute for Children's Health Quality.

Update on Evaluation, Prevention, and Management of Postpartum Hemorrhage

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 43(2):120, March/April 2018.

The American College of Obstetricians and Gynecologists has updated their guidelines on postpartum hemorrhage. Review the October 2017 practice bulletin and work with the multidisciplinary team on your unit to adopt the recommendations to promote patient safety.

Vaginal Seeding of Babies Born via Cesarean

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 43(1):60, January/February 2018.

With growing interest in the microbiome and its implications for health, more research is evolving on how interventions during labor and birth influence newborn and infant microbiota. Some parents are requesting vaginal seeding of their babies born via cesarean. Possible benefits are theoretical and research to date is quite limited, however, there are significant potential risks of unintended harm if infection is transferred to the baby with this procedure. A brief summary of vaginal seeding is offered with recommendations for practice.

Sudden Unexpected Postnatal Collapse and Sudden Unexpected Infant Death

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 42(6):368, November/December 2017.

Current recommendations from the American Academy of Pediatrics and the Association of Women's Health, Obstetric, and Neonatal Nurses for continuous bedside attendance by nurses for mothers and babies during the recovery period and regular monitoring of mother-baby couplets during postpartum hospitalization are supported by numerous large case series reports of sudden unexpected postnatal collapse in the hospital setting.

Safe Nurse Staffing is More than Numbers and Ratios

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 42(5):304, September/October 2017.

Safe staffing is not numbers or ratios, rather the essential nursing care for optimal outcomes. Productivity targets should financially support enough nurses to provide care that is required based on national standards and guidelines. The numbers recommended in the AWHONN (2010) staffing guidelines represent the ability to perform that requisite nursing care.

Minimizing Unnecessary Interventions During Labor and Birth

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 42(4):240, July/August 2017.

A call to minimize unnecessary interventions during labor and birth for healthy low risk women in spontaneous labor by our colleagues at the American College of Obstetricians and Gynecologists is most welcome and has been endorsed by the American College of Nurse-Midwives and the Association of Women's Health, Obstetric, and Neonatal Nurses.

Disruptive Behavior in the Clinical Setting: Implications for Patient Safety

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 42(3):188, May/June 2017.

Disruptive clinician behavior continues to be a problem in the clinical setting and increases risk of preventable harm to mothers and babies. A new committee opinion from the American College of Obstetrician and Gynecologists offers updated information about this type of behavior in our practice specialty and how to address it.

Labor Nurses' Views of Their Influence on Cesarean Birth

Simpson, Kathleen Rice; Lyndon, Audrey

MCN, The American Journal of Maternal/Child Nursing. 42(2):81-87, March/April 2017.

Nurses play an important role in helping women in labor avoid avoid a cesarean birth. They offer emotional encouragement, various labor support techniques, and information on what to expect as strategies to promote vaginal birth. They focus on the positve aspects of labor progress when communicating with physicians. The dynamics of the nurse-physician relationship is at times challenging as labor nurses do not always perceive their physician colleage share the same goals and investment for mode of birth.

Avoiding Adverse Events after Postpartum Hospital Discharge

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 42(2):124, March/April 2017.

The hospital discharge process for new mothers and babies after childbirth is not always as comprehensive and individualized as it should be. Recommendations from the Agency for Healthcare Research and Quality for avoiding adverse events after hospital discharge are discussed and applied to postpartum and newborn care.

Maternal Mortality in the United States: We Must Do Better

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 42(1):64, January/February 2017.

In the United States, maternal death is more common than in many other developed countries and while there have been decreases in maternal mortality in other countries, there have been increases here. The continued rise in maternal deaths is a health crisis and a national tragedy that can be addressed in part with everyone working together to adopt evidence based childbirth practices and by reviewing near miss cases as a team.

Distinguish Yourself: Get an ORCID

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 42(1):E1-E2, January/February 2017.

Every author needs a unique identifier that works to avoid confusion with others with the same, similarly spelled, or like-sounding names and is maintained over the course of their writing and research career. MCN supports the use of ORCID.

Length of Second-Stage Labor: Safety Considerations

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 41(6):380, November/December 2016.

Extending the duration of second stage labor beyond what has traditionally been considered standard may be beneficial in promoting vaginal birth. However, there are small but significant risks to mother and baby. Thus careful consideration, including periodic assessment of maternal and fetal wellbeing and chances of successful vaginal birth, should be occurring as a team. A collaborative discussion between the labor nurse and birth attendant that covers these two important clinical points at least every hour when second stage labor pushing exceeds 2 hours for nulliparous women and 1 hour for multiparous women may be a valuable safety measure.

Evaluating Quality of Second-Stage Labor Care

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 41(5):316, September/October 2016.

The condition of the baby at birth is a potentially valuable indicator of the quality of care during the second stage of labor. Consider using Apgar scores less than 7 at one minute as criteria for selecting cases for team review. Use the lessons learned to change practice accordingly.

Missed Nursing Care in the Perinatal Setting

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 41(4):260, July/August 2016.

Missed nursing care is a concept that has been studied widely over the past few years, but not in maternity or neonatal units. For the purposes of measurement, missed care has been conceptualized by researchers as nursing care that is not done in a timely manner, not done as completely as needed, or not done at all (i.e., delayed, unfinished, or missed care). Missed nursing care is worthy of study in the perinatal setting because we all know when nurses are too busy, things can get missed.

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